Effect of virtual reality versus dry lab training on technical skills in robotic surgical simulation: a systematic review and meta-analysis

BACKGROUND: Virtual reality (VR) and dry lab (DL) platforms are widely used for robotic surgery training, yet their comparative effectiveness remains uncertain, particularly for suturing skills. METHODS: A systematic review of controlled studies comparing VR with physical robotic simulation was conducted; meta-analysis was restricted to VR versus DL studies. PubMed, Embase, MEDLINE, and the Cochrane Library were searched. The primary outcome was post-training technical performance; task completion time was secondary. Pooled standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated using random-effects models. RESULTS: Ten studies (333 trainees) were included in the qualitative synthesis, and six (168 participants) in the quantitative analysis. DL training showed significantly higher post-test technical performance (SMD - 0.43; 95% CI - 0.74 to - 0.12). In RCTs (n = 89), the difference was not significant (SMD - 0.15; 95% CI - 0.57 to 0.27). Fixed-time curricula favored DL (SMD - 0.51; 95% CI - 0.96 to - 0.05), whereas proficiency-based progression showed no difference. Task completion time was similar between modalities (MD 0.14; 95% CI - 0.43 to 0.70). CONCLUSIONS: DL training was associated with higher post-test technical performance overall, but not in the RCT-only analysis; task completion time was similar between modalities. Both approaches may have complementary roles depending on curriculum, task, and trainee characteristics.